The Peter Attia Drive

The Peter Attia Drive will feature guests and experts that will offer advice and insight to help you optimize performance, health, longevity, critical thinking, and life. It’s hosted by Stanford M.D., TED speaker, and longevity expert Dr. Peter Attia, founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City.

Special episode with Dax Shepard: F1 and the 30th anniversary of Ayrton Senna’s death 04/29/2024

Special episode with Dax Shepard: F1 and the 30th anniversary of Ayrton Senna’s death This is a special episode of The Drive with Peter’s friend and fellow car enthusiast Dax Shepard. In this podcast, which commemorates the 30th anniversary of the death of Brazilian Formula One legend Ayrton Senna, Dax sits down with Peter to better understand what made Senna so special and why Peter remains an enormous fan. This conversation focuses on Senna’s life, the circumstances of his death, and his lasting impact and legacy on the sport of F1. We discuss: Peter’s interest in motorsports began as a child [2:30]; The drama and dangers of F1 [6:00]; What made Senna special [13:00]; What Senna meant to Brazilians [24:00]; The cause of the fatal crash [28:15]; Why Peter is obsessed with Senna [40:30]; Being the best versus having the best record [43:30]; Senna’s unique driving style and incredible intuition about automotive engineering [46:30]; Back to the day of the dreadful race [53:00]; What Peter believes caused the crash [1:02:45]; Views on dying young, in the prime of life [1:13:00]; Senna lives on in his foundation and in safety changes adopted by F1 [1:21:00]; Statistics aren’t enough for fandom, and why people like who they do [1:24:15]; The biggest difference between F1 today and F1 in the 80s [1:28:30]; Senna’s driving superpower [1:30:30]; The fastest drivers currently in F1 [1:38:30]; Current F1 obsessions [1:45:00]; How hard it is to do what the top F1 drivers do [1:50:15]; Dax’s love of motorcycles and his AMG E63 station wagon [1:52:15]; Awesome Senna mementos from Etsy [2:01:15]; What makes specialists interesting, and Max’s devotion to F1 [2:10:15]; What Senna might have done if he had not died that day [2:14:00]; Michael Schumacher and Max Verstappen are also top F1 drivers [2:17:30]; Interlagos in Sao Paulo Brazil is always an incredible experience [2:18:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30993078

#299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D. 04/22/2024

#299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D. Luc van Loon is an internationally renowned expert in skeletal muscle metabolism. In this episode, Luc starts with an exploration of the roles of insulin and triglycerides in endurance exercise, highlighting their impact on skeletal muscle metabolism, and he offers profound insights into the significance of protein in this context. He elucidates how different protein types and forms influence muscle protein synthesis rates, exploring the nuances of protein absorption, digestibility, amino acid quality, and their implications for performance and recovery. Delving deeper, he differentiates between animal and plant protein sources, unraveling the distinctive properties of various protein types, from the differences between whey and casein to the emerging trends in collagen protein supplementation. Moreover, Luc dissects the intricate connections among physical activity, lean muscle mass, muscle protein synthesis induced by resistance training, and dietary protein. We discuss: Luc’s background and insights about fuel selection during exercise [3:30]; Fuel utilization during endurance exercise [9:30]; Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15]; The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15]; Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15]; How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45]; The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30]; How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45]; Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30]; Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00]; Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15]; Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30]; Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00]; How to preserve muscle while trying to lose weight [1:46:00]; Anabolic resistance and overcoming it with physical activity [1:55:45]; Importance of protein intake and physical activity in hospitalized patients [2:06:30]; Reviewing the efficacy of collagen supplements [2:13:30]; Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30]; Future research: understanding protein metabolism in the brain [2:23:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30892518

#298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more | Paul Conti, M.D. 04/15/2024

#298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more | Paul Conti, M.D. Paul Conti is an author and practicing psychiatrist who specializes in helping people heal from trauma. In this episode, Paul returns to The Drive to delve into the intricate relationship between emotional health, healthspan, and lifespan. He first challenges common assumptions about the inevitable decline of emotional health with age, providing strategies for conducting a comprehensive audit of internal emotional health. He establishes a framework for the foundation of good emotional health: a balance between the generative drive, the assertive drive, and the pleasure drive. Paul also explores the nuanced dynamics of motivation, happiness, and satisfaction as it relates to material possessions, draws connections between physical and emotional well-being, confronts the impact of negative self-talk, and describes how making peace with our mortality can foster a sense of hope, purpose and well-being. Additionally, Paul offers many practical insights into initiating emotional health improvements and navigating the search for a suitable therapist. We discuss: The importance of prioritizing emotional health as we age [2:45]; The impact of emotional health on healthspan and how to foster a proactive approach to emotional well-being [7:00]; The discrepancy between outward success and inner fulfillment, and the importance of a healthy “generative drive” for genuine well-being [13:00]; A deeper dive into generative drive: impact on human behavior, resilience, purpose, and more [23:15]; Evaluating one’s inner self: introspection, self-awareness, challenging societal norms, and returning to the basics of physical and emotional well-being [29:00]; Self-auditing tools: introspection, curiosity, and exploring underlying reasons for unwanted behaviors [41:45]; Breaking free from destructive cycles by understanding the continuum of self-care and addictive behaviors and remaining curious [50:15]; Critical self talk: the malleability of one’s inner dialogue and the potential for transformative change with perseverance and self-compassion [1:00:15]; Slowing the anger response and gaining insights into the underlying triggers to achieve lasting change and self-understanding [1:13:45]; Foster gratitude and humility by achieving balance between the three drives—assertion, pleasure, and generative [1:20:45]; The conflict between intellectual understanding and emotional feelings, problematic comparison frameworks, and the importance of living in the present with intentionality [1:24:15]; How making peace with our mortality can foster a sense of hope, purpose and well-being [1:34:45]; Advice for finding a compatible therapist [1:43:45]; The key components of therapeutic progress [1:57:00]; The caricatures of four common patient phenotypes, and how to get through to them [2:05:30]; How Paul manages his own well-being and the emotional challenges that come with his line of work [2:15:15]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30790648

#297 - AMA #58: Iron: its role in health, testing methods, and strategies for preventing and managing iron deficiency 04/08/2024

#297 - AMA #58: Iron: its role in health, testing methods, and strategies for preventing and managing iron deficiency In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial yet often overlooked topic of iron and iron deficiency. He explores why iron is indispensable for the body, explains the repercussions of iron deficiency, and sheds light on the prevalence of this issue and who is most susceptible. Peter outlines strategies for increasing iron levels, covering dietary iron, supplementation, and infusion options, while also discussing the suitability of each approach for different individuals. Shifting gears, Peter tackles rapid-fire questions on creatine and sodium, as well as inquiries related to his book. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Overview of today’s topics and the importance of understanding iron levels in the body [1:45]; The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30]; The processes of iron absorption, utilization, and transportation [9:30]; Options for testing iron levels and how to interpret the results [13:45]; What does it mean to be iron deficient, and how is it different from anemia? [17:15]; Symptoms of iron deficiency and/or anemia [22:15]; How prevalent is iron deficiency, and who is most susceptible? [24:30]; The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30]; The best way to improve iron levels for someone who is deficient [34:45]; Iron supplementation: various formulations and potential side effects [37:45]; Intravenous iron infusion as an alternative to oral supplements -- plus restless legs syndrome and other topics [42:00]; Iron supplementation: who should and should not consider it [44:00]; Peter’s approach to creatine and his pre- and post-workout supplements [50:15]; Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45]; Peter’s thoughts about the potential of writing another book [57:15]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30598093

#296 ‒ Foot health: preventing and treating common injuries, enhancing strength and mobility, picking footwear, and more | Courtney Conley, D.C. 04/01/2024

#296 ‒ Foot health: preventing and treating common injuries, enhancing strength and mobility, picking footwear, and more | Courtney Conley, D.C. Courtney Conley is an internationally renowned foot and gait specialist. In this episode, Courtney delves into the intricate world of foot anatomy and functionality. She explores the complexities of the foot, discussing its anatomy, common injuries, and the importance of understanding its structure in preventing issues. She covers a range of foot ailments, factors contributing to them, treatment options, and prevention strategies. She delves into the significance of loading, balance, range of motion, and posture, emphasizing the crucial role of strength in preventing both injuries and falls. Additionally, she sheds light on the interconnectedness of the kinetic chain, from the leg muscles down to the foot, and how issues within this chain can cascade downstream, leading to various injuries and pathologies. Additionally, she provides a comprehensive overview of footwear, discussing suitable options for both adults and children to promote foot health and mitigate potential problems. In addition to this interview, Courtney also recorded a series of videos to better explain a number of the concepts discussed such as diagnostic tests that are used to determine mobility and strength and the exercises one should perform to improve the outcomes based on the diagnostics. The interview will be available to everyone while the videos from the gym will only be available to paid subscribers (found at the end of the show notes page). We discuss: Why Courtney chose to specialize in the foot [3:30]; The vital role of foot strength, function, and health in human movement and well-being [6:15]; Anatomy of the rear foot and midfoot [10:15]; The development of flat feet, the impact of footwear, and the benefits of going barefoot [19:45]; Anatomy of the forefoot, common injuries, and why most injuries occur in the forefoot [23:15]; Foot musculature and its role in maintaining foot stability and preventing deformities like bunions and hammer toes [30:15]; The intrinsic musculature of the foot, plantar fasciitis, footwear, and more [39:00]; Plantar fasciitis: diagnosis, causes, and treatment [51:30]; Posterior leg muscles: strength assessment methods, role in ACL injuries, and more [59:15]; Lateral and medial muscles: ankle stability, arch support, big toe stabilization, and exercises to strengthen and prevent injuries [1:04:15]; Importance of strength of lower leg muscles for gait and preventing shin splints, stress injuries, and more [1:08:15]; Tendinopathies and other common pathologies related to the anterior and lateral compartments of the foot [1:13:00]; The importance of midfoot integrity, ankle dorsiflexion, and a discussion of gait alterations [1:19:45]; Proximal stability and its implications for posture and movement patterns [1:27:00]; The age-related decline in foot sensation and strength [1:32:45]; Common toe injuries, treatment, and how to prevent further progression of the injury [1:36:30]; Preventing falls and managing arthritis with proactive foot care and exercises [1:46:45]; Footwear: advice for picking shoes that promote foot health [1:54:45]; Footwear for runners [2:05:30]; The importance of prioritizing footwear that promotes natural foot movement and strength while considering individual comfort and foot health needs [2:09:30]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30550608

#295 ‒ Roadway death and injury: why everyone should care and what you can do to reduce risk | Mark Rosekind, Ph.D. 03/25/2024

#295 ‒ Roadway death and injury: why everyone should care and what you can do to reduce risk | Mark Rosekind, Ph.D. Mark Rosekind is an expert on road safety and a policy leader with more than 30 years of experience enacting strategic, practical, and effective data-based solutions that enhance driver and pedestrian safety and health in complex environments. In this episode, Mark delves into the persistent issue of accidental deaths resulting from roadway accidents, a concern for those focused on longevity given its consistent risk throughout life. From exploring statistics on car crashes to identifying the demographics most at risk and the key locations of incidents, he uncovers various risk factors including distractions like smartphone usage, the influence of alcohol and cannabis, the dangers of sleep deprivation, and speeding. Mark also provides practical advice for both drivers and pedestrians to enhance safety, while delving into the potential and challenges of emerging technologies such as autonomous vehicles. Additionally, Mark provides valuable resources for listeners, particularly parents navigating the road safety landscape with teenage drivers. We discuss: Mark’s background and education, and the profound impact of transportation accidents on human lives [4:15]; From sleep science to safety leadership: Mark’s journey in transportation innovation [14:15]; Stats on transportation accidents and fatalities [18:00]; Historical trends in road fatalities and the key contributors—impairment, distraction, and more [28:00]; The demographics of drivers involved in crashes, and the life-saving potential of better driver education programs [34:30]; The most critical areas where drivers need to be hyper-aware to protect themselves [41:00]; The role of the National Transportation Safety Board (NTSB) in accident investigations, and the importance of data sources like event data recorders (EDRs) in accident reconstruction and investigations [47:00]; The dangers of phone use while driving [53:45]; How drunk driving was addressed through advocacy and legal changes [1:01:30]; The need to address distracted driving and the psychological impact of distracted driving accidents on both victims and perpetrators[1:07:15]; Navigating the roads and lowering your risk of accidents: weather, human error, and defensive driving [1:15:45]; The impact of impaired driving: alcohol, cannabis, prescription drugs, and more [1:26:15]; Mitigating the effects of vehicle speed [1:38:15]; The promise and challenges of autonomous vehicles for road safety [1:44:15]; Automatic emergency braking (AEB): the effectiveness and challenges of implementing AEB as a standard feature in new vehicles [1:53:00]; Sleep deprivation: the impact of poor sleep, drowsiness, and disrupted circadian rhythm on driving [1:58:15]; Protecting pedestrians: strategies for reducing the risk of fatal accidents with pedestrians on foot or bicycle [2:02:30]; Empowering safe driving: essential resources and tips for parents and teenage drivers [2:14:00]; Promoting a culture of proactive safety: parting thoughts from Mark [2:19:15]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30465718

#294 ‒ Peak athletic performance: How to measure it and how to train for it from the coach of the most elite athletes on earth | Olav Aleksander Bu 03/18/2024

#294 ‒ Peak athletic performance: How to measure it and how to train for it from the coach of the most elite athletes on earth | Olav Aleksander Bu Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav delves deep into the intricacies of VO2 max and its profound impact on performance. They explore the relationship between VO2 max and ATP production, energy efficiency, and power, as well as the impact of low-intensity training on VO2 max. The conversation extends to Olav’s experiences pushing the boundaries with high-performance athletes and the data driven interventions he uses to improve performance. They also dissect the role of lactate threshold, discuss other important metrics to track, and explore the exciting possibility of utilizing a portable VO2 testing device as a practical alternative to traditional lab-based assessments. We discuss: Olav’s background, expertise in exercise physiology, coaching experience, and interest in the extremes of human capability [4:15]; The processes of energy conversion within the human body and its implications for performance [9:30]; Improving movement efficiency, and the importance of mindfulness in training to optimize performance [20:00]; The relationship between VO2 max, power output, and endurance performance in different sporting contexts [34:45]; How VO2 max is measured in the lab, and why it’s a crucial predictor of both lifespan and quality of life [44:45]; Absolute vs relative VO2 max, the significance of functional threshold power in cycling, and the importance of longer duration tests for accurate assessments [54:00]; Portable VO2 testing devices as a practical alternative to lab-based tests [1:05:15]; The complexities of measuring ventilation and its impact on performance metrics like VO2 max and heart rate [1:15:45]; Training interventions to increase VO2 max, and factors that impact performance outcomes [1:23:30]; The respiratory exchange ratio (RER) and endurance sports, and how factors such as diet composition and exercise intensity influence RER values and performance [1:32:45]; Science-guided training for versatile athletes: maximizing VO2 max, power, torque, and cadence in cycling, and the importance of incorporating diverse stimuli to enhance performance [1:41:00]; Physiological limitations on VO2 max [2:02:15]; The different energy systems used during work, and other things to monitor like VCO2 and heart rate [2:06:00]; Lactate threshold and other metrics to guide your training [2:10:30]; Analysis of a lactate power curve: exploring lactate dynamics in endurance training and performance [2:23:15]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30298513

#293 - AMA #57: High-intensity interval training: benefits, risks, protocols, and impact on longevity 03/11/2024

#293 - AMA #57: High-intensity interval training: benefits, risks, protocols, and impact on longevity In this “Ask Me Anything” (AMA) episode, Peter delves into the topic of high-intensity interval training (HIIT), starting with addressing some common misunderstandings around this type of exercise and breaking down what HIIT truly entails. He examines the correlation between HIIT and VO2 max, a vital metric for overall health and longevity, and describes the beneficial impact of HIIT on longevity when incorporated properly. Additionally, he emphasizes the importance of building a wide base of cardiovascular fitness, reveals the optimal protocols for incorporating HIIT into a balanced routine, and discusses the risk of injury and other potential drawbacks of HIIT. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Common questions about high-intensity interval training (HIIT) [1:30]; The origins of HIIT [3:15]; Defining HIIT training and differentiating it from sprint interval training (SIT) [5:45]; Why HIIT is often touted as a more efficient way to exercise [14:00]; Navigating the nuances of HIIT research: understanding limitations and the importance of a blended exercise routine [20:30]; The four pillars of exercise [24:15]; Using HIIT to improve VO2 max [26:00]; HIIT training for the untrained individual: impact on VO2 max and the interplay between exercise-induced adaptations and potential weight loss [33:00]; Sprint interval training (SIT) vs. HIIT: comparing the relative improvements in VO2 max and the impact of longer duration intervals [40:00]; Benefits and limitations of HIIT, drawbacks of overtraining with HIIT, and the importance of a diversified routine to increase total cardiorespiratory capacity [44:15]; HIIT protocols Peter recommends [58:45]; The risk of injury and other potential drawbacks of HIIT [1:02:15]; The importance of incorporating a balance of continuous moderate-intensity cardio and HIIT when aiming for longevity [1:04:00]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30247818

#292 ‒ Rucking: benefits, gear, FAQs, and the journey from Special Forces to founding GORUCK | Jason McCarthy 03/04/2024

#292 ‒ Rucking: benefits, gear, FAQs, and the journey from Special Forces to founding GORUCK | Jason McCarthy Jason McCarthy is a former US Special Forces member and the founder of GORUCK, a company specializing in rucking equipment. In this episode, Jason recounts his journey from military service to navigating the challenging transition back into civilian life and ultimately embracing the mission of introducing rucking to the masses. Delving into the significance of rucking in military training and its applicability to the wider population, he discusses the mental and physical benefits of rucking as a mode of training, provides practical tips for beginners, and answers frequently asked questions about packs, weights, footwear, and more. We discuss: Jason’s upbringing and what inspired him to join the military [3:15]; Jason’s path to becoming a Green Beret, his calling to serve, and staying true to oneself [10:30]; About the Green Berets: their role in the military, unique abilities, missions, and more [20:00]; The mental and physical challenges of special forces training and selection [25:00]; Rucking challenges as a Green Beret [37:00]; How Jason trained in his off-time and stayed mentally prepared [46:30]; Jason’s difficult decision to leave the army, and the challenges many veterans face returning to civilian life [51:30]; Jason’s struggles after leaving the army: loss of identity, feelings of shame, and the how he overcame a period of despair [57:15]; The origin of GORUCK [1:10:30]; The GORUCK Challenge [1:24:30]; The company's evolution from event organizer to manufacturing specialist, spurred by the growing interest in rucking as a form of training [1:35:30]; FAQs about rucking: packs, weight, rucksack vs. weighted vest, chest straps, and more [1:38:45]; Commemorating Normandy: GORUCK's plans for the 80th anniversary of the Normandy landings [1:51:30]; Footwear for rucking, and how GORUCK got into the footwear business [1:57:30]; How to avoid the most common injuries from rucking, and the benefits of rucking for VO2 max, strength, and sleep quality [2:05:00]; Advice for using rucking as a mode of training, and the advantages of rucking over other forms of training [2:12:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30158893

#291 ‒ The role of testosterone in males and females, performance-enhancing drugs, sustainable fat loss, supplements, and more | Derek, More Plates More Dates Pt.2 02/26/2024

#291 ‒ The role of testosterone in males and females, performance-enhancing drugs, sustainable fat loss, supplements, and more | Derek, More Plates More Dates Pt.2 Derek is a fitness educator, the entrepreneur behind More Plates More Dates, and an expert in exogenous molecules commonly used and misused by bodybuilders and athletes. In this episode, Derek returns to the podcast to explore the impact of exogenous molecules on male and female health. He covers testosterone, DHT, DHEA, progesterone, clomiphene (Clomid), hCG, and various peptides, alongside updates from the FDA affecting peptide use. Additionally, he addresses the recent hype around increasing muscle mass through myostatin inhibition via follistatin gene therapy and supplementation. Additionally, Derek discusses the various strategies that bodybuilders use for losing fat while preserving muscle, including insights on weight loss drugs. We discuss: Testosterone and DHT: mechanisms of action, regulation of muscle growth, and influence on male and female characteristics [2:15]; TRT in women: the complexities and potential risks associated with testosterone use in women [9:00]; DHEA supplementation: exploring the benefits and risks for women, and the differing effects on men vs. women [22:00]; The role of progesterone in both men and women, pros and cons of supplementation, the importance of tailored doses, and more [28:00]; Measuring levels of free testosterone [37:15]; The trend towards earlier interest in TRT, and the risks of underground sources of testosterone [42:00]; The complexities and considerations surrounding the use of Clomid, E-Clomid, and hCG in TRT [46:00]; Low testosterone: diagnosis, potential causes, treatment options, and other considerations [53:45]; Growth hormone-releasing peptides: rationale and implications of the recent FDA categorization as high-risk substances [1:03:45]; Follistatin gene therapy and myostatin inhibition for increasing muscle mass: the recent hype online, human and animal data, and the need for more research [1:14:45]; Simple tips for lowering calorie intake and losing fat [1:32:30]; Methods of sustainable fat loss with muscle preservation: insights gleaned from bodybuilders [1:40:00]; Could prolonged fasting impact testosterone levels? [1:55:30]; High-protein ice cream [1:57:00]; Exploring fat loss supplements and drugs: L-carnitine, yohimbine, and more [2:02:15]; Potential remedies for individuals experiencing metabolic dysfunction due to hypercortisolemia [2:12:30]; The cornerstones of body composition improvement remain nutrition and exercise, even in the presence of exogenous testosterone [2:19:15]; The importance of approaching health advice found online with a critical eye and a healthy dose of skepticism [2:23:30]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/30069858

#290 ‒ Liquid biopsies for early cancer detection, the role of epigenetics in aging, and the future of aging research | Alex Aravanis, M.D., Ph.D. 02/19/2024

#290 ‒ Liquid biopsies for early cancer detection, the role of epigenetics in aging, and the future of aging research | Alex Aravanis, M.D., Ph.D. Alex Aravanis is a leader in research and development of technologies and clinical tests utilizing the latest tools in DNA analysis and data science. In this episode, Alex delves into two interconnected topics: liquid biopsies and epigenetics. He begins by tracing the trajectory of genome sequencing and tumor sequencing, setting the stage for a detailed exploration of liquid biopsies as an early cancer detection method. The discussion encompasses key concepts such as cell-free DNA, DNA methylation, sensitivity, specificity, and the predictive values associated with liquid biopsies. Transitioning to epigenetics, Alex examines the intricate interplay of DNA methylation and aging biology and explores the possibility of using cellular reprogramming to reverse epigenetic changes that occur with aging. We discuss: Alex’s background in applying engineering to problems in medicine [3:15]; A primer on human genetics, and the history and current landscape of DNA sequencing [11:00]; The advent and evolution of liquid biopsies for early detection of cancer [23:15]; The role of cell-free DNA in cancer detection: how incidental findings in non-invasive prenatal testing led to the development of liquid biopsies [40:15]; The development of a universal blood test for cancer detection and a discussion of specificity of tests [46:00]; Advancements in cell-free DNA analysis and development of a multi-cancer screening test at GRAIL [51:00]; DNA methylation explained [58:15]; Optimizing cancer detection with methylation analysis of cfDNA in small blood samples [1:02:45]; The importance of understanding sensitivity, specificity, positive predictive value, and negative predictive value in cancer screening [1:08:00]; The performance of the GRAIL Galleri test and its ability to detect various types and stages of cancer [1:21:00]; Do early cancer detection methods, like liquid biopsies, translate to improvement in overall survival? [1:27:45]; The role of epigenetics in aging [1:39:30]; How cell-free DNA methylation patterns can help identify a cancer’s tissue of origin [1:45:30]; Cellular and epigenetic reprogramming and other exciting work in the field of aging [1:52:30]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29976903

#289 - AMA #56: Cancer screening: pros and cons, screening options, interpreting results, and more 02/12/2024

#289 - AMA #56: Cancer screening: pros and cons, screening options, interpreting results, and more In this “Ask Me Anything” (AMA) episode, the conversation focuses on cancer screening, a topic often shrouded in confusion yet crucial to understand given that early identification of a cancer is an essential part of survival strategy. Peter examines the arguments both for and against cancer screening, including addressing why some trials may show no benefit to screening. He then delves into the various screening modalities available for different cancers, highlights the pros and cons associated with each, and explains how to interpret the results. Additionally, Peter provides guidance for navigating outside of the relatively narrow and confined screening guidelines for various types of screening tests. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Why understanding cancer screening is crucial [2:45]; The prevalence of cancer diagnosis and mortality rates [4:30]; Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00]; Data on how cancer screening impacts survivability of cancer [16:30]; Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45]; What are some of the reasons why clinical trials don’t always improve cancer-specific mortality? [30:15]; What are the arguments against population-level cancer screening? [42:00]; Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00]; Understanding sensitivity and specificity when reviewing screening results [52:30]; Risks and complications associated with colonoscopies [55:45]; Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30]; The strengths and limitations of various types of cancer screening [1:02:15]; Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45]; Factors that influence an individual's pretest probability of cancer [1:13:45]; How to interpret cancer screening results [1:18:15]; The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30]; How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30]; Advice and guidance for making decisions related to cancer screening [1:31:15]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29880663

#288 ‒ The impact of gratitude, serving others, embracing mortality, and living intentionally | Walter Green 02/05/2024

#288 ‒ The impact of gratitude, serving others, embracing mortality, and living intentionally | Walter Green Walter Green is a remarkable philanthropist, mentor, author of This Is the Moment!, and founder of the impactful “Say It Now” movement. In this episode, Walter delves into the unique insights gained from his challenging upbringing, discusses embracing mortality, and highlights the mindset of “finishing strong.” He shares insights on intentionality, thinking in reverse, saying “no,” prioritizing relationships, and the essence of focusing on others. The conversation focuses on the “Say It Now” movement, which stresses the importance of expressing sentiments to loved ones well before the end of life. We discuss: How Peter and Walter met through Ric Elias [2:45]; The unique perspectives and life lessons provided by Walter’s challenging childhood [5:30]; Walter’s harrowing experience with a sudden mental breakdown and his subsequent recovery with the help of therapy [11:15]; A diverse professional journey ending in great success [18:15]; The birth of a movement: celebrating friendships through public tributes and expressing gratitude to those who have shaped your life’s journey [22:30]; Intentionality, thinking in reverse, saying “no”, and other guiding principles for Walter [30:00]; Walter’s global journey of gratitude on his 70th birthday: visiting friends and creating memorable experiences [39:15]; The profound impact of acknowledging and expressing gratitude for the people who contribute to our lives [46:15]; The key elements for creating meaningful connections and cultivating deep, authentic friendships [52:15]; The “Say It Now” movement: the inspiration behind the remarkably impactful initiative [58:30]; What “finishing strong” means to Walter [1:07:30]; Finding peace at the end of life through expressing gratitude and finding purpose in serving others [1:16:00]; Resources to learn about “Say It Now” [1:26:15]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29761738

#287 ‒ Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. 01/29/2024

#287 ‒ Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine. We discuss: Peter’s experience with debilitating back pain [3:30]; Anatomy of the back: spine, discs, facet joints, and common pain points [14:45]; Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:45]; Why the majority of back injuries happen around the L4, L5, and S1 joints [31:00]; How the spine responds to forces like bending and loading, and how it adapts do different athletic activities [36:15]; The pathology of bulging discs [43:15]; The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [46:00]; The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:15]; The significance of strength and stability in preventing injuries and preserving longevity [1:08:15]; Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:30]; Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:30:00]; Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:39:00]; When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:45]; Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:30]; Tarlov cysts: treatment and surgical considerations [2:00:15]; The evolution of patient assessments and the limitations of MRI [2:02:15]; Pain relief related to stiffness and muscle bulk through training [2:07:00]; Advice for the young person on how to keep a healthy spine [2:14:15]; Resources for individuals dealing with lower back pain [2:25:30]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29654533

#286 ‒ Journal club with Andrew Huberman: the impact of light exposure on mental health and an immunotherapy breakthrough for cancer treatment 01/22/2024

#286 ‒ Journal club with Andrew Huberman: the impact of light exposure on mental health and an immunotherapy breakthrough for cancer treatment Andrew Huberman, professor of neurobiology at Stanford University and host of the Huberman Lab podcast, returns for another special journal club episode. Andrew introduces an observational study investigating the influence of light exposure on circadian clock regulation and its link to mental health, while Peter covers a phase III clinical trial employing immune checkpoint inhibitors for the treatment of metastatic cancer. They delve into the essential findings of their respective papers, elucidate the reasons for their enthusiasm, and tackle potential limitations and unanswered questions. Additionally, they provide valuable insights into their approaches for comprehending research studies, aiding listeners in independently navigating this process. We discuss: The intricate relationship between light exposure, circadian rhythms, and mental health [3:30]; The importance of low solar angle sunlight, and other types of light needed for optimal mental and physical health [12:00]; Promising new lightbulb technology that simulates low solar angle sunlight [17:45]; The significance of both darkness and the need for direct light exposure to the eyes, specifically [20:00]; Some tips and advice regarding optimizing light exposure, blue blockers, and effects on circadian rhythm [22:15]; Andrew presents a paper which suggests avoiding light at night and seeking light during the day is associated with better mental health [25:45]; Examining the data: the negative impact of increasing nighttime light exposure and the positive effects of daytime light exposure [34:30]; Statistical analysis: the importance of focusing not only on statistical significance but also clinical relevance, power analysis, error bar range, and more [45:45]; Takeaways from the study of daytime and nighttime light exposure [49:45]; The practicalities of minimizing light exposure and screen time at night, the use of sleep trackers, and overall challenge of modern, indoor lifestyles [55:15]; Potential limitations of the light exposure study, reverse causality, and the complex interplay of variables in epidemiological studies [1:06:00]; A tangent on diet soda and sugar substitutes as an example of reverse causality [1:13:15]; Andrew and Peter’s take on the causality vs. correlation of light exposure to mental health, the damage of circadian disruption, and the interpretation of observational data [1:17:30]; A primer on the immune system as background for the paper Peter chose [1:25:00]; Background on cancer: causes, how it evades the immune system, and the logic behind immune checkpoint inhibitor therapy [1:35:45]; Peter presents a paper on immune checkpoint inhibitor therapy in cancer patients [1:50:15]; Unpacking the results of the checkpoint inhibitor trial [1:59:45]; Other noteworthy observations, including the differing results between males and females [2:15:30]; Adverse effects resulting from treatment with an immune checkpoint inhibitor targeting CTLA-4 [2:20:00]; Why melanoma is especially responsive to immunotherapy, and the remarkable success story of immunotherapy for pancreatic cancer [2:25:15]; Why immunotherapy may be the most important hope we have for treating cancer [2:35:30]; Avoiding melanoma: the sunscreen debate, sunburn as the biggest risk factor, and more [2:38:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29566163

#285 - AMA #55: Exercise: longevity-focused training, goal setting, improving deficiencies, managing emotional stress, and more 01/15/2024

#285 - AMA #55: Exercise: longevity-focused training, goal setting, improving deficiencies, managing emotional stress, and more In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial topic of exercise, starting with the importance of having a goal in training, including how and why Peter uses the goal of training for the “Centenarian Decathlon” when structuring his training plans. Peter elaborates on how to identify deficient areas within the four pillars of exercise and guides listeners on incorporating periodization training for optimal improvement and training variety. The episode explores diverse case studies, offering insights into tailored workouts for individuals of various training backgrounds, from seasoned enthusiasts to complete beginners. Additionally, Peter tackles the universal issue of emotional stress and its impact on training, as well as how exercise can help manage stress and how to determine when training should be adjusted during a high-stress period. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Overview of exercise topics [2:15]; Importance of training with a goal in mind, the Centenarian Decathlon, and the natural decline of fitness with age [4:00]; The four pillars of exercise [12:15]; Measuring peak aerobic output with VO2max, and the importance of VO2max as a predictor of longevity [16:45]; Measuring aerobic efficiency with zone 2 [25:45]; Measuring and tracking muscle mass and strength [27:30]; Case study of a fit person with a neglected pillar: why adding more training volume may not the best strategy [30:30]; Periodization training: what it is and why it is beneficial [36:15]; Periodization case study: high cardio fitness, lacking muscle and strength [40:00]; Periodization case study: adequate muscle, low cardio fitness [44:45]; Case study: significant improvement needed across all exercise pillars [48:45]; Best ways to do zone 2 exercise and how to use relative perceived exertion (RPE) to find your zone 2 level [56:30]; How the body responds to physical and emotional stress, its impact on training, and the consequences of chronic stress [1:01:00]; The difference between “good” stress and “bad” or chronic stress [1:10:30]; The complex relationship between exercise and stress, and the importance of adjusting exercise goals during high-stress periods [1:13:30]; Clues that stress may be impacting your training [1:19:15]; The use of wearables and devices for tracking trends and making decisions related to training [1:21:00]; Parting thoughts regarding the importance of exercise for longevity and stress management [1:32:00]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29434888

#284 ‒ Overcoming addictive behaviors, elevating wellbeing, thriving in an era of excess, and the scarcity loop | Michael Easter, M.A. 01/08/2024

#284 ‒ Overcoming addictive behaviors, elevating wellbeing, thriving in an era of excess, and the scarcity loop | Michael Easter, M.A. Bestselling author Michael Easter returns to The Drive to discuss his new book, Scarcity Brain. In this episode, Michael explores the evolutionary backdrop that molded human beings, a setting characterized by scarce food, limited information, and few possessions. He contrasts that with the modern era, marked by abundance and comfort, and the ensuing repercussions on our physical and mental well-being. Michael introduces the concept of the “scarcity loop,” a three-part behavior cycle which helps explain modern challenges such as overeating, addiction, gambling, and materialism, and offers practical strategies to break free from its cycle. The episode culminates in a thought-provoking exploration of happiness, drawing on Michael's experiences with monks and underscoring the value of boredom, exploration, and discomfort as transformative elements that elevate awareness, presence, and the will to live. We discuss: Inspiration for Michael’s latest book, Scarcity Brain [2:15]; Evolutionary adaptations to the scarcity of food contrasted with the modern obesity crisis [4:00]; Lessons learned about diet and nutrition from living with hunter-gatherers [9:30]; The impact of ultra-processed foods on energy balance [20:30]; Michael’s experience with attempting the hunter-gatherer diet at home [27:30]; The roots of excess: factors that contribute to overeating and the varied vulnerabilities among individuals [34:00]; The scarcity loop: how components of the scarcity loop are illustrated in gambling and addiction [39:45]; Using knowledge of the scarcity loop to break the cycle [50:45]; The evolutionary drive to acquire material possessions [58:15]; The benefits of boredom and value of exploration [1:07:00]; The consequences of an attention economy driven by negativity bias [1:16:30]; Navigating the world of endless information and the value in “slow information” [1:23:00]; Defining happiness, and the downward trend in reports of happiness [1:33:00]; Purpose, austerity, self-reliance and other missing elements of happiness gleaned from the study of monks [1:38:30]; The value in uncomfortable activities that increase your awareness, presence, and will to live [1:48:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29329018

James Clear: Building & Changing Habits (#183 rebroadcast) 01/01/2024

James Clear: Building & Changing Habits (#183 rebroadcast) James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the “Four Laws of Behavioral Change.” In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one’s self-identity. Finally, James breaks down his “Four Laws of Behavioral Change” and how to use them to create new habits, undo bad habits, and make meaningful changes in one’s life. We discuss: Why James became deeply interested in habits [2:00]; Viewing habits through an evolutionary lens [6:15]; The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:30]; The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:45]; How finding one’s passion can cultivate perseverance and discipline [23:30]; Advantages of creating systems and not just setting goals [29:30]; The power of habits combined with self-identity to induce change [36:45]; How a big environmental change or life event can bring on radical behavioral change [50:45]; The influence of one’s social environment on their habits [54:30]; How and why habits are formed [1:00:45]; How to make or break a habit with the “Four Laws of Behavior Change” [1:09:45]; Practical tips for successful behavioral change—the best strategies when starting out [1:16:30]; Self-forgiveness and getting back on track immediately after slipping up [1:30:45]; Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:40:00]; Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:48:00]; Law #3: Make it easy—the 2-minute rule [1:59:00]; Law #4: Make it satisfying—rewards and reinforcement [2:03:45]; Advice for helping others to make behavioral changes [2:06:15]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29137528

#283 ‒ Gut health & the microbiome: improving and maintaining the microbiome, probiotics, prebiotics, innovative treatments, and more | Colleen Cutcliffe, Ph.D. 12/18/2023

#283 ‒ Gut health & the microbiome: improving and maintaining the microbiome, probiotics, prebiotics, innovative treatments, and more | Colleen Cutcliffe, Ph.D. Colleen Cutcliffe is an expert in molecular biology and co-founder of Pendulum Therapeutics, a company working to develop treatments for a variety of diseases by targeting the microbiome. In this episode, Colleen delves into the complexity of the microbiome, how it is tested, and how it changes over time. She explores how probiotics, prebiotics, and postbiotics affect the gut and makes a compelling case that well-developed products have the potential not only to enhance gut health but also to positively influence overall metabolic well-being. Colleen emphasizes the significance of a high-fiber diet in sustaining a thriving gut microbiome, shares insights on minimizing microbiome damage during antibiotic use, provides tips for fostering and preserving a healthy gut, and much more. We discuss: Colleen’s background and current focus [4:45]; The basics of the microbiome [7:15]; The study of the human microbiome [15:15]; Categories of bacteria, and the implications on health of the rapid evolution of bacteria [19:45]; Methods for measuring and understanding the microbiome, and key indicators of microbiome health [28:30]; The important role of fiber for promoting gut health through the production of butyrate [38:30]; The case for manipulating gut bacteria via fecal microbiota transplant (FMT) [45:00]; Dynamics of the microbiome: the gut-brain connection and how antibiotics, nutrition, stress, and more impact the microbiome's diversity and function [50:15]; Factors that influence the vaginal microbiome [55:15]; The effect of gut microbes on obesity and challenges with fecal transplants in people [58:45]; Beneficial strains of gut bacteria and strains commonly found in probiotics [1:01:15]; The difference between a probiotic and prebiotic, and how CFUs are a measure of the “active ingredient” [1:09:45]; Considerations about how probiotic strains are produced, and more on the meaning of CFU [1:14:15]; Mitigating the effect of antibiotics on the microbiome [1:22:30]; What do we know about the effect of artificial sweeteners on the gut microbiome? [1:30:00]; Why Akkermansia is a keystone strain with implications for metabolic health and an individual’s response to dietary interventions [1:36:15]; The essential steps necessary to develop a robust probiotic for optimal health support [1:45:45]; How Akkermansia helps control blood glucose, and potential implications of Akkermansia in weight loss, diabetes management, and more [1:48:45]; Pendulum Therapeutics’ commitment to rigorous product develop [2:06:30]; Details about the probiotic “Glucose Control” and other probiotics developed by Pendulum Therapeutics [2:13:00]; Further studies of Akkermansia that have been proposed or are underway [2:20:30]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/29086493

#282 - AMA #54: Magnesium: risks of deficiency, how to correct it, supplement options, potential cognitive and sleep benefits, and more 12/11/2023

#282 - AMA #54: Magnesium: risks of deficiency, how to correct it, supplement options, potential cognitive and sleep benefits, and more In this “Ask Me Anything” (AMA) episode, Peter tackles essential questions about magnesium, beginning with the important roles it plays in the body and why maintaining proper levels is crucial. Peter discusses the harms of magnesium deficiency, how to determine if you're deficient, potential causes of deficiency, and how diet and supplementation can be used to increase magnesium levels. Peter unravels the confusion surrounding magnesium supplementation, discussing the optimal forms and recommended daily intake while addressing concerns about excess consumption. He also explores the potential cognitive and sleep benefits associated with magnesium supplementation. Finally, Peter concludes with a look into his recent experimentation with new exercises to serve as benchmarks to assess his progress and fitness levels as he navigates the aging process. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: The important roles of magnesium in the body [2:45]; How to determine if you might be deficient in magnesium [10:15]; Addressing migraines related to low magnesium [14:45]; The prevalence of magnesium deficiency [16:30]; Various conditions and drugs that can negatively impact magnesium levels [21:30]; Magnesium-rich foods and factors that impact absorption of magnesium [24:30]; Daily targets for magnesium supplementation and whether it’s possible to take too much [30:15]; The different forms of supplemental magnesium [34:00]; How absorption of magnesium from food compares to absorption from supplements [36:15]; Choosing the right magnesium supplements for optimal absorption [37:15]; The unique ability of magnesium L-threonate to increase brain magnesium concentration [40:15]; Potential cognitive benefits of magnesium [43:00]; Potential sleep benefits of magnesium [48:45]; Takeaways on magnesium and a look into Peter’s personal protocol [53:15]; Peter’s new benchmarks related to exercise and age [58:30]; and The potential impact of hearing loss on brain health and neurodegeneration [2:04:30]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28979688

#281 ‒ Longevity drugs, aging biomarkers, and updated findings from the Interventions Testing Program (ITP) | Rich Miller, M.D., Ph.D. 12/04/2023

#281 ‒ Longevity drugs, aging biomarkers, and updated findings from the Interventions Testing Program (ITP) | Rich Miller, M.D., Ph.D. Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan, as well as a previous guest on The Drive. In this episode, Rich provides an update on the exciting work of the Interventions Testing Program (ITP), an initiative designed to assess potential life-extending interventions in mice. Rich covers the notable successes like rapamycin, 17⍺-estradiol, and acarbose as well as notable failures like nicotinamide riboside, metformin, and resveratrol, providing valuable lessons about the intricacies of the aging process. Rich delves deep into aging biomarkers and aging rate indicators, unraveling crucial insights into the science of geroprotective molecules. Additionally, Rich discusses some surprising successes of recent molecules tested by the ITP and concludes with an optimistic look at future frontiers, including bridging the gap from mice to humans. We discuss: An overview of the Interventions Testing Program (ITP) [3:45]; How the mice used by the ITP are superior for research relative to mouse models used in most research [11:15]; Design of ITP studies, outcomes tested, and metrics of interest [19:00]; The process and challenges of drug formulation for mice [30:00]; Four drugs identified by the ITP that extends the lifespan of mice [36:30]; The success of rapamycin and what it tells us about the biology of aging [43:15]; Other measures of healthspan evaluated by the ITP in stage 2 studies [50:45]; Distinguishing aging rate indicators from biomarkers of aging [57:30]; Aging rate indicators identified through the examination of slow-aging mice [59:15]; Why proteomics are essential to understand changes in the cell [1:12:15]; Unraveling aging rate indicators: dose-effect, duration, and future frontiers [1:21:45]; A closer look at aging rate indicators: bridging the gap from mice to humans [1:27:00]; What do laboratory mice die from? [1:38:45]; Distinguishing between a drug that improves an age-sensitive outcome and a drug that improves all aspects of aging [1:42:00]; The ITP study of 17⍺-estradiol: mechanisms of life extension and surprising sex differences [1:43:30]; Unsuccessful drugs studied by the ITP: resveratrol, metformin, and nicotinamide riboside [1:51:30]; Over-the-counter successes in the ITP: meclizine and astaxanthin [2:01:00]; A senolytic drug, fisetin, fails to extend lifespan [2:07:00]; Can targeting senescent cells slow aging? [2:13:00]; Optimism about future findings [2:16:30]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28870468

#280 ‒ Cultivating happiness, emotional self-management, and more | Arthur Brooks Ph.D. 11/27/2023

#280 ‒ Cultivating happiness, emotional self-management, and more | Arthur Brooks Ph.D. Arthur Brooks is a social scientist, professor at Harvard University, columnist for The Atlantic, and bestselling author. In this episode, Arthur returns to the podcast to discuss his new book, Build the Life You Want. He delves into the nuanced concept of happiness, differentiating between momentary feelings and overall wellbeing. He explains the importance of understanding one’s personality pattern with respect to positive and negative emotions in order to better self-manage emotions. He delves into the three key elements of happiness, offering practical strategies for enhancing those specific domains through methods such as metacognition, transcendent experiences, discipline, minimizing self-focus while directing attention outward, and more. Through personal examples, Arthur demonstrates that one can actively track well-being levels and take intentional steps to cultivate happiness and enhance overall well-being. We discuss: Happiness vs. happy feelings, and how happiness and unhappiness can coexist [4:30]; The six fundamental emotions [8:00]; The evolution and heritability of happiness, and the four personality patterns with respect to positive and negative emotions [17:30]; Navigating relationships: the power of complementarity over compatibility [23:30]; The importance of self-managing your mental habits [25:30]; Enjoyment: one of the three macronutrients of happiness [32:00]; Satisfaction: one of the three macronutrients of happiness [43:45]; The reverse bucket list, metacognition, and other techniques to protect yourself from your limbic system [51:00]; Meaning: one of the three macronutrients of happiness [57:30]; The four quarters of your life and how that relates to the meaning of your life [1:05:00]; Putting metacognition into practice [1:09:00]; What might explain the societal downdrift in happiness over the last few decades? [1:17:00]; Taking charge of your happiness: discipline, transcendent experiences, and other deliberate actions for happiness [1:30:30]; Tracking happiness: biomarkers and micronutrients behind the macronutrients of happiness [1:42:00]; The value in minimizing the self and looking outward [1:49:45]; How Arthur surprised himself with his ability to improve his happiness [1:54:00]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28739363

The world’s most important doctor to millions in the war-torn and remote villages of Sudan | Tom Catena, M.D. (#40 rebroadcast) 11/20/2023

The world’s most important doctor to millions in the war-torn and remote villages of Sudan | Tom Catena, M.D. (#40 rebroadcast) To support Tom’s mission and work, please visit: https://africanmissionhealthcare.org/donation/catena/. In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast to the ubiquity of chronic disease and self-harm in the West, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who, despite their suffering, live so harmoniously, happily, and resiliently. We discuss: Background, medical training, and early days of missionary work in Africa [5:15]; Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [12:30]; Learning surgery on the job and earning the trust of the community [37:00]; The amazing people of Nuba, and why Nuba feels like home to Tom [47:45]; NY Times article about Tom’s work, and Tom’s new venture on the board of the Aurora Prize Foundation, raising awareness and funds for other missionaries [59:45]; Tom’s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:12:00]; The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:19:45]; The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:30:00]; The logistical challenge of helping Tom’s hospital, and what Tom really needs [1:35:15]; Diseases in the adult population [1:38:30]; Living without possessions, finding meaning, and being a missionary [1:55:45]; Happiness, sense of purpose, and suicide: contrasting the US with Nuba [2:07:15]; Other than donations, is there a way people can help Tom and other similar causes? [2:15:15]; The food in Nuba [2:18:30]; Tom’s annual bout of malaria [2:23:45]; Patients Tom will never forget [2:26:00]; Resources for people wanting to get involved in helping Tom’s work [2:31:00]; Peter tells a story that defines Tom [2:32:00]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28584208

#279 - AMA #53: Metabolic health & pharmacologic interventions: SGLT-2 inhibitors, metformin, GLP-1 agonists, and the impact of statins 11/13/2023

#279 - AMA #53: Metabolic health & pharmacologic interventions: SGLT-2 inhibitors, metformin, GLP-1 agonists, and the impact of statins In this “Ask Me Anything” (AMA) episode, Peter explores various pharmacologic tools commonly utilized to improve metabolic health and treat diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines the available data on these drugs, assessing their comparative effectiveness and their potential in the context of lifestyle interventions. Additionally, he offers insights into whether SGLT2 inhibitors hold promise as geroprotective agents beyond their effects on glycemic control. Next, Peter analyzes the relationship between statin usage and the risk of developing insulin resistance and type 2 diabetes, investigating possible causal pathways and providing insights into strategies for risk reduction. He offers insights on monitoring adverse statin effects and evaluating the need for adjustments, ultimately weighing the trade-off between the risk to overall metabolic health against the benefits of reducing apoB levels through statin use. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Pharmacologic tools for improving metabolic health, and the relationship between statins and insulin resistance [2:00]; SGLT-2 inhibitors: how they work and help to manage type 2 diabetes [4:15]; The history of SGLT2 inhibitors – from discovery to the current state [10:15]; Comparing the various FDA-approved SGLT2 inhibitors [15:00]; Other beneficial effects of SGLT2 inhibitors outside of glycemic control [20:15]; Exploring SGLT2 inhibitors as potential geroprotective molecules [22:45]; The side effects and risks associated with SGLT2 inhibitors [31:45]; Medications, lifestyle interventions, and other considerations for treating diabetes and improving metabolic health [37:45]; Metformin as a tool for pre-diabetics, and how metformin compares to lifestyle interventions [44:00]; How GLP-1 agonists compare to metformin and SGLT2 inhibitors in terms of glycemic control and weight loss [49:15]; Exploring the relationship between statin use and the risk of developing insulin resistance and type 2 diabetes [52:30]; Possible mechanisms of statin-induced insulin resistance and diabetes, and potential mitigation strategies [1:04:30]; How to monitor for adverse effects of statin use and assess the need for adjustments [1:11:45]; Weighing the benefits and risks of statin use: does the diabetes risk outweigh the benefits of lowering apoB with a statin? [1:15:30]; Parting thoughts [1:20:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28583828

#278 ‒ Breast cancer: how to catch, treat, and survive breast cancer | Harold Burstein, M.D., Ph.D. 11/06/2023

#278 ‒ Breast cancer: how to catch, treat, and survive breast cancer | Harold Burstein, M.D., Ph.D. Harold (Hal) Burstein is an internationally renowned breast cancer expert. In this episode, Hal discusses a broad range of topics related to breast cancer, starting with the intricacies of breast anatomy and the endocrinological factors at play. He covers the spectrum of breast cancer, from precancerous lesions to invasive breast cancer, classifying these conditions into a helpful framework. He delves into various screening methods, including self-exams, mammograms, ultrasounds, and MRIs, and addresses the ongoing debate surrounding early screening and detection. Hal provides insights into the latest advancements in cancer treatment, offering valuable guidance for individuals to understand their unique circumstances within the three primary categories of breast cancer. Finally, Hal delves into the role of genetics in breast cancer and brings attention to the less commonly addressed issue of male breast cancer. We discuss: The prevalence and mortality rate of breast cancer in women [4:15]; The anatomy of the breast and the complex factors behind breast cancer development [6:30]; The three main categories of breast cancer [16:45]; Breast cancer risk: the impact of menopause, estrogen, breast density, obesity, and more [21:15]; Finding and evaluating lumps in the breast [25:30]; Identifying and treating precancerous lesions like ductal carcinoma in situ (DCIS) [31:00]; Post-lumpectomy for DCIS: standard of care, future risk of cancer, and pros and cons of radiation and other preventative options [41:15]; Lobular carcinoma in situ (LCIS): how it differs from DCIS in terms of treatment and future risk of invasive cancer [55:00]; Breast cancer screening: mammography, ultrasound, MRI, and more [1:03:45]; Invasive breast cancer: pathology report, surgery, and survival [1:11:00]; The argument for aggressive screening for breast cancer [1:22:15]; Advances in the treatment of breast cancer, adjuvant therapy, and neoadjuvant therapy [1:27:00]; The use of hormone replacement therapy in women who are in remission from breast cancer [1:41:15]; The role of genetics in breast cancer [1:44:45]; The importance of multidisciplinary care delivered by cancer centers [1:53:15]; Breast cancer in men [2:03:30]; Parting thoughts and takeaways [2:05:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28477685

#277 ‒ Food allergies: causes, prevention, and treatment with immunotherapy | Kari Nadeau, M.D., Ph.D. 10/30/2023

#277 ‒ Food allergies: causes, prevention, and treatment with immunotherapy | Kari Nadeau, M.D., Ph.D. Kari Nadeau is a physician scientist with expertise in treating food allergies. In this episode, Kari first explains the fascinating workings of the immune system, exploring how it adeptly defends against bacteria and viruses but how the same system can lead to food allergies. She proceeds to explore the complexities of food allergies, detailing their typical developmental patterns, underscoring the significance of preventative approaches like early exposure, and highlighting the potentially life-threatening nature of severe food allergies. Kari illuminates the latest advancements in immunotherapies that not only mitigate allergy severity but also hold the potential to completely cure the patient. Additionally, Kari shares her concerns about the increasing levels of air pollution, elucidating its adverse effects on health while providing valuable suggestions for reducing exposure. We discuss: Kari’s motivation to study food allergies [4:00]; Overview of the immune system and the family of immunoglobulins [9:00]; How our immune system fights viruses, bacteria, or fungi, and some exceptions to the rule [13:00]; Why our immune system is generally better at fighting viruses than bacterial infections [18:45]; Differentiating a food sensitivity from a food allergy, and a discussion about celiac disease [25:30]; How food allergies develop, why they can be lethal, and factors contributing to the uptrend in food allergies [35:45]; The role of environmental factors in the onset of food allergies and strategies for prevention [50:15]; How immunotherapy helps to overcome, and even cure, food allergies [1:04:15]; Can immunotherapy work for environmental allergens like pollen? [1:24:00]; Air pollution: impact on health and tips for reducing your risk [1:25:30]; Resources for those wanting to learn more or find clinical trials related to food allergies [1:40:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28423661

#276 ‒ Special episode: Peter answers questions on longevity, supplements, protein, fasting, apoB, statins, and more 10/23/2023

#275 - AMA #52: Hormone replacement therapy: practical applications and the role of compounding pharmacies 10/16/2023

#275 - AMA #52: Hormone replacement therapy: practical applications and the role of compounding pharmacies In this "Ask Me Anything" (AMA) episode, the discussion zeroed in on the practical application of hormone replacement therapy in women. Peter walks through the signs, symptoms, and hormonal changes in women approaching – and going through – menopause. He provides an overview of the FDA-approved HRT formulations and explains how women might go about choosing the right option for themselves. Peter also describes the significant changes in testosterone levels in women over time and the options, as well as the considerations and challenges of testosterone replacement therapy (TRT) for women. Lastly, Peter highlights the necessary role of compounding pharmacies in HRT, underscores concerns regarding the quality and sterility of compounded drugs, and offers guidance on locating a trustworthy pharmacy. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your or our website at the . If you are not a subscriber, you can learn more about the subscriber benefits . We discuss: Why hormone replacement therapy is such an important topic [2:00]; The onset of menopause: symptoms, blood tests, and when to consider HRT [6:00]; Tests that may provide indications of perimenopause and their implications for fertility [9:15]; Vasomotor symptoms: hormonal changes that cause hot flashes/night sweats, and HRT therapies that can help [13:45]; The role of estrogen in menopausal HRT [17:30]; The limited role of progesterone in HRT protocols [25:15]; What is a “bioidentical” hormone? [28:30]; Overview of the FDA-approved HRT formulations [31:45]; Determining HRT dosing and considerations for perimenopausal women [37:45]; Choosing the right HRT formulation: pros and cons [43:30]; Examining the link between certain forms of estrogen and breast cancer [46:45]; Changes in testosterone levels in women over time and why it matters [50:00]; Recognizing low testosterone in women: common symptoms and diagnosis [53:45]; Testosterone replacement therapy for women: options, considerations, and challenges [57:30]; The long-term use of testosterone in women: examining the limited data [1:00:15]; What is a compounding pharmacy? [1:09:30]; Reasons to opt for a compounding pharmacy over a pharmacy that adheres to stricter regulations [1:16:00]; The tragic incidents that heightened concerns about compounding pharmacies [1:20:45]; Tips for finding a reputable compounding pharmacy [1:27:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28303889

#274 - Performance-enhancing drugs and hormones: risks, rewards, and broader implications for the public | Derek: More Plates, More Dates 10/09/2023

#274 - Performance-enhancing drugs and hormones: risks, rewards, and broader implications for the public | Derek: More Plates, More Dates We discuss: Derek’s interest in weightlifting and experimentation with anabolic steroids at a young age [3:15]; Derek’s experience acquiring steroids from underground labs and the potential long-term fertility concerns early in his bodybuilding career [12:00]; The backstory on More Plates, More Dates and Derek’s unique ability to blend scientific knowledge with personal observation [17:00]; Growth hormone – from extreme use-cases to the more typical – and the misconception that it’s the “elixir of life” [21:30]; Growth hormone 101: definition, where it comes from, and the challenges of measuring it [28:45]; Does exogenous growth hormone compromise one’s ability to make endogenous growth hormone? [40:00]; The use of growth hormone in restoration of tissue during periods of healing [42:00]; Growth hormone-releasing peptides to increase endogenous GH: various peptides, risks, benefits, and comparison to exogenous growth hormone [48:45]; The role of growth hormone in building muscle and burning fat, as well as its effects on sleep and daytime lethargy [1:02:30]; The evolution of drug use in the sport of bodybuilding [1:10:30]; What explains the protruding abdomens on some bodybuilders and athletes? [1:20:30]; Death of bodybuilders [1:26:00]; The complex interplay of hormones, and the conversion of testosterone into metabolites like DHT and estrogen [1:33:45]; Post-finasteride syndrome and how Derek successfully treated his hair loss [1:43:15]; Testosterone replacement therapy: compelling use-cases, side effects, and optimal dosing schedules [1:57:15]; Aromatase inhibitors to suppress estrogen, and the misconceptions around estrogen in men [2:16:00]; Other hormones beyond testosterone for male sex hormone replacement [2:21:00]; The history of anabolic compounds, and the differing effects of various anabolic testosterone derivatives and related drugs [2:24:30]; Use of SARMs by bodybuilders [2:29:45]; Anabolic steroid and testosterone regimens of professional bodybuilders and the downstream consequences [2:36:15]; The challenge of accurate hormone testing in the presence of anabolic steroids and supplements [2:44:45]; The use of Clomid, hCG, and enclomiphene [2:47:15]; Concerns about fertility: comparing the use of testosterone and hCG [3:00:30]; The use of BPC-157 peptide for healing injuries [3:12:00]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28226303

#273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more | Ted Schaeffer, M.D., Ph.D. 10/02/2023

#273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more | Ted Schaeffer, M.D., Ph.D. Ted Schaeffer is an internationally recognized urologist who specializes in prostate cancer. In this episode, Ted delves deep into the realm of prostate health, starting with strategies for vigilance and effective management of the issues that can arise with aging, including urinary symptoms, prostatitis, pelvic pain, and prostate inflammation. Ted sheds light on the popular drug finasteride, renowned for its dual purpose in prostate shrinkage and hair loss prevention, as well as the contentious topic of post-finasteride syndrome. Ted then shifts to the topic of cancer, explaining how androgens, genetics, and non-genetic factors contribute to the pathogenesis of prostate cancer. He provides valuable insights into cancer screening, examining blood-based screening tools like PSA and the use of MRI in facilitating biopsies and their interpretation. Finally, he explores the various treatment options for prostate cancer, including surgical interventions, androgen deprivation therapy, and more. We discuss: Changes to the prostate with age and problems that can develop [3:45]; Behavioral modifications to help manage nocturnal urinary frequency and other lower urinary tract symptoms [8:30]; Pharmacologic tools for treating nocturnal urinary frequency and lower urinary tract symptoms [16:30]; Surgical tools for treating symptoms of the lower urinary tract [26:15]; HoLEP surgery for reducing prostate size [32:30]; Prostate size: correlation with cancer and considerations for small prostates with persistent symptoms [40:30]; Prostatitis due to infection: symptoms, pathogenesis, and treatment [46:45]; Prostatitis caused by factors besides infection [58:45]; How to minimize risk of urosepsis in patients with Alzheimer’s disease [1:05:00]; Prostate cancer: 5-alpha reductase inhibitors, how androgens factor into pathogenesis, and more [1:10:00]; Post-finasteride syndrome [1:18:15]; The relationship between testosterone and DHT and the development of prostate cancer over a man's lifetime [1:26:30]; How genetic analysis of a tumor can indicate the aggressiveness of cancer [1:35:15]; Pathogenesis and genetic risk factors of prostate cancer and the use of PSA to screen for cancer [1:37:45]; Non-genetic risk factors for prostate cancer [1:45:45]; Deep dive into PSA as a screening tool: what is PSA, definition of terms, and how to interpret results [1:56:30]; MRI as a secondary screening tool and the prostate biopsy options [2:13:15]; Ted’s ongoing randomized trial comparing different methods of prostate biopsy [2:24:00]; Determining when a biopsy is necessary, interpreting results, explaining Gleason score, and more [2:27:00]; Implications of a Gleason score of 7 or higher [2:46:45]; Metastasis of prostate cancer to different body locations, treatment options, staging, and considerations for patients' quality of life and survival [2:53:30]; How prostate cancer surgery has improved [3:09:30];; Questions to ask your neurologist if you are considering prostatectomy for cancer [3:21:45]; and More. Connect With Peter on , , and /episode/index/show/peterattiadrive/id/28170668

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